From the Editor: Let’s talk about the stigmatizing language in B.C.’s monkeypox vaccination program

For the past couple of weeks, I’ve been calling out some of British Columbia’s health authorities for the language they are using in promoting the monkeypox vaccine to gay and bisexual men and transgender people. 

In the links to book the monkeypox vaccine, Fraser Health,  Vancouver Coastal Health, Vancouver Island Health, and Interior Health all use the same language: eligible individuals are men or transgender people who self-identify as gay, bisexual, or men who have sex with men “AND” — emphasis included — have a sexually transmitted disease, multiple sexual partners in the past 21 days, are planning to engage in venues like bathhouses, or are engaged in sex work. 

I thought we learned from the HIV and AIDS crisis in the 1980s and 90s to avoid stigmatized language. HIV disproportionately spread in the gay community among men, but the spread wasn’t limited to this group. HIV spread through anal and vaginal sex or by sharing needles. It was years before the general public understood HIV spread through blood regardless of sexuality or gender, and today gay and bisexual men and transgender people are still fighting policies founded on discriminatory beliefs from that era — such as Canada’s blood donation ban. 

I’m not dismissing the fact that these communities are at a high-risk for contracting monkeypox, the data shows this to be true for gay and bisexual men in social and sexual networks. I’m ridiculing the emphasis B.C. health authorities are placing on sex between men who have sex with men and transgender people. 

The difference between HIV and monkeypox is that one is actually a sexually transmitted infection (STI) and the other is not. According to the World Health Organization (WHO), more studies are needed to determine if monkeypox can even be transmitted “specifically through sexual routes.” Although with their latest announcement for gay and bisexual men to “limit their sexual partners,” they’ve only added to the growing stigma and misunderstanding around monkeypox transmission. 

The general medical consensus is the monkeypox virus spreads through contact with sores or blisters, infected bedding or towels, and close, face-to-face contact with someone who has monkeypox. Close contact includes sexual partners, as well as people who live in the same household due to risk of respiratory transmission from infected droplets through sneezing or coughing — although this is not a source of primary transmission, thankfully. 

The BC Centre for Disease Control (BCCDC) also says monkeypox is not known to be sexually transmitted and anyone in “close direct contact” with a case of the virus is at risk. Further, they make a point of noting that stigmatizing any community will “hinder appropriate infection prevention and control efforts.” 

The language B.C.’s health authorities are using in their monkeypox vaccination program suggests monkeypox is an STI within the gay, bisexual, and transgender communities. This not only contributes to the harmful stigma these communities face and possibly deters them from getting vaccinated at all, but also suggests people who are not part of these communities can take fewer precautions regardless of their sexual activities. 

I don’t expect public health officials to regulate the public’s reaction to the fact these communities are disproportionately affected by the monkeypox virus. I expect them to use appropriate language in their services, because they should be aware of the harm any other language will contribute to the stigma of gay and bisexual men and transgender people. 

The lesson from the HIV and AIDS 1980s crisis is that this already stigmatized minority needs to be protected without stigma. 

The B.C. health authorities should change the language in their vaccination campaigns, such as including that these communities are “disproportionately affected” by the monkeypox virus and provide accurate details on how the virus spreads — similar to the BCCDC’s page, which doesn’t have so much emphasis on STIs and instead focuses on “close contact.” 

They should also issue an apology to gay and bisexual men and transgender people for the inappropriate language previously used. This way people most at risk might be more open to a vaccine and it will help reduce the spread of stigma. 

I have more respect for an authority that apologizes for their mistake, than one who silently fixes their words. I hope to see a good example in my province.